Profile of adult care classified as non-urgent in emergency care unit

Objective: To identify the profile of care classified as non-urgent in the Emergency Care Unit (ECU). Methods: This is a descriptive, retrospective, documentary study with a quantitative approach, carried out in an ECU located in the city of Curitiba, PR, with users from 18 years of age and blue priority in the risk classification. Data were tabulated in Excel® and analyzed in SPSS® to obtain descriptive statistics, inferences and perform the chi-square test. Results: 213 medical records were analyzed, predominantly looking for young adults, with a mean age of 39 years, female. The main clinical complaints/demands reported ( p< 0.001) by users were: respiratory and flu problems (36%), followed by medication administration (14%) and unprotected sexual exposure (8%). Morning calls (39%) were more frequent ( p< 0.001), with Monday and Wednesday being the days with the highest demand ( p= 0.026). The most common outcome of the


___________________________________________________________________________________________________________________________________________________________ INTRODUCTION
The Health Care Network (HCN), established by Ordinance number 4,279, of December 30, 2010, is defined as a set of health actions and services, organized in different technological densities, which are integrated by technical, logistical and management support systems seeking to ensure comprehensive care to the users.One of the components that integrates HCN is the Emergency Care Network (ECN) that was implemented in Brazil in 2011, after the Ministry of Health reformulated the National Policy for Emergency Care.As a component of the ECN, the Emergency Care Units (ECU) stand out, health establishments with an intermediate complexity structure, which operate 24 hours a day, every day of the week, intended to meet urgent and emergency situations in acute chronic cases or acute cases of clinical, surgical or trauma character.5) In the ECU, users are categorized according to the risk they present, through Risk Classification (RC), which is an instrument, in the protocol format, used to support the clinical decision, in order to identify the severity of the users and allow rapid care, according to the potential risk that it presents.) The increasingly accentuated demand of users with clinical complaints classified as non-urgent leads to the mischaracterization of the real attributions that the ECU performs, as it absorbs demands that could be solved in less complex units, such as the Basic Health Unit (BHU).This contributes to the overcrowding of these establishments, interferes with the quality of care provided, generates long waiting English | Rev. enferm.UFPI.2024;13:e5466| DOI: 10.26694/reufpi.v13i1.5466periods, causes the wear and tear of professionals, compromises the quantity of human and material resources to meet greater demand and results in surplus financial expenses to health systems (7)(8) Knowing the reasons that lead users to seek the ECU is essential to improve the management of urgency and emergency services, assist in the execution of a more accurate and personalized screening, allow better administration of available resources, ensure efficiency and resoluteness in care, enable appropriate referrals to the demands brought and contribute to the improvement of care flows within health care networks.In addition, the results can provide valuable information to support the construction of strategies to strengthen Primary Health Care. (7)onsidering the Emergency Care Network and the different points of health care, as well as the purpose of the Emergency Care Units and how users are categorized within this service, we seek to identify the profile and demands that lead users with non-urgent complaints to seek services for urgent and emergency care.Thus, the objective of this study is to identify the profile of care classified as non-urgent in the Emergency Care Unit.

METHODS
This is a descriptive and retrospective study, with a quantitative approach, carried out in an Emergency Care Unit (ECU) located in the city of Curitiba -PR.The unit offers urgent and emergency medical and nursing care to adults and children by spontaneous demand or referral from other services, to all users of the Unified Health System (SUS).
We included electronic medical record data of users treated at the ECU, aged eighteen years or older, of both sexes, categorized with the blue priority (non-urgent) in the risk classification, treated from July 1 to December 31, 2022.The medical records of users whose access to care information was not available were excluded.
For the sample calculation, the total number of users treated at the ECU classified as blue (nonurgent) in the period from July 1, 2022 to December 31, 2022 (1569 visits) was considered, in a stratified manner, calculated from the total number of visits, with 95% confidence and a margin of error equal to 5%, reaching a sample of 213 (13.6% of the population).
Based on the information provided in the municipality's health system, a structured instrument was used to collect data containing the following information: sex; age; date and time of care; vital signs; flowchart (protocol service flow defined by the municipal management); main medical diagnosis and ICD (International Classification of Disease); complaints referred by the users in the risk classification; main complaint referred by the users; conduct/outcome of care.Access to this information was made through the electronic medical record of the municipality of Curitiba, used in the institution.To extract the data present in the medical records, the participants were named with the letter "P" followed by an ordinal numeral referring to the established collection sequence (P1, P2, P3,...).
Data were collected between May and July 2023 and tabulated in Microsoft Excel® software spreadsheets.For the descriptive analysis, categorical variables were presented according to their frequencies and percentages of occurrence.For continuous variables, the Shapiro-Wilk test was used to test normality.In the variables with normal distribution (systolic and diastolic blood pressure; p > 0.123) the data were presented as mean and standard deviation, while in the variables with violated normality (heart and respiratory rate, oxygen saturation and body temperature; p < 0.001) the data were presented as median and interquartile range 1 and 3 (25 th and 75 th percentiles).
The presentation of this information was done in tables, formatted in Microsoft Word®.For the inferential analyses, the data tabulated in Excel were transferred to the Statistical Package for the Social Sciences (SPSS) software, version 23/2015.In order to compare the characteristics of the care (shift, day of the week, flowchart, main complaint, conduct), the chi-square test was used.The same test was also applied to compare the days of the week and the main complaint of the consultations between the different age groups.The significance of all analyses was determined at 5% (p<0.05).
This research was evaluated by the Ethics and Research Committee of the Municipal Health Department of Curitiba (SMS/Curitiba), receiving a favorable opinion under number 5.905.706 on February 22, 2023, in compliance with the guidelines of the National Health Council established by Resolution 466/12 for the execution of research involving human beings. (9)rofile of adult care classified as non-urgent... English | Rev. enferm.UFPI.2024;13:e5466| DOI: 10.26694/reufpi.v13i1.5466

RESULTS
We analyzed 213 medical records of care provided in the ECU; the highest demand was for young adult users in the first two age groups (mean=39 ±15), with ages ranging from 18 to 86 years and predominance of females.The demand for care was mainly concentrated in the morning and afternoon shifts, with no significant difference in demand during the opening hours of the BHU (similar distribution).The days with the highest number of visits were Monday and Wednesday.The general characteristics of the care are presented in Table 1.Source: the authors (2024).
Table 2 presents specific characteristics about the flowchart, the main complaint referred by the user, the ICD assigned and the conduct/outcome of the service.There was a significant difference in the distribution of all analyses.Regarding the flowchart, the most prevalent was malaise in adults (n=143; 67%), followed by COVID (n=27; 13%).The main clinical complaints reported by users were respiratory and flu-like problems (n=76; 36%), followed by medication administration (n=29; 14%) and unprotected sexual exposure (n=18; 8%).The predominant ICDs observed in these consultations were: U07.2 (clinical or epidemiological diagnosis of COVID-19, when laboratory confirmation is inconclusive or not available), Z00.0 (general medical examination) and Z53.2 (procedure not performed due to the user's decision for other reasons and not specified).Regarding the conduct/outcome of care, most users were discharged (n=131; 61%), followed by medication (n=42; 20%) and evasion from the establishment (n=24; 11%).Source: the authors (2024).
In addition to these care characteristics, some vital signs were measured in users, such as: systolic (SBP) and diastolic (DBP) blood pressure; heart rate (HR) and respiratory (RF); body temperature and oxygen saturation.For each variable, a descriptive analysis was conducted.Descriptive values of vital signs are found below in Table 3.The data indicate, on mean, normality in the categorization of measures for all variables.Users with extreme values are outside the normal parameters for all measurements.English | Rev. enferm.UFPI.2024;13:e5466| DOI: 10.26694/reufpi.v13i1.5466 In addition, the lack of clear and accessible information about which health service to seek in the face of a clinical or traumatic complication is a significant issue that influences the decision of users to seek care in urgent and emergency services, especially those who are unfamiliar with the functioning of the health care network. Regarding the main clinical complaints presented by users, respiratory and flu complaints, medication administration and unprotected sexual exposure predominated.Regarding the search for respiratory and flu complaints, the present study resembles others as one of the main reasons for seeking care, both in adults and children.The justification for this predominance was associated with the cold climate of the region, where the present study was conducted.In addition to the seasonality of the presence of respiratory infections related to cold weather, it is crucial to consider the pandemic context related to the SARS-CoV-2 coronavirus.During the pandemic, attention around respiratory symptoms increased significantly.Symptoms associated with COVID-19, such as cough, fever and difficulty breathing, have become a cause for concern for users and health professionals, leading to a more frequent search for care. The search for the ECU for the administration of intravenous or intramuscular medication, with medical prescriptions from other services, whether from the SUS, health plans or private offices, proved to be a common practice among the users of this study.This dynamic of seeking care for procedures that are not emergency or urgent may have implications for the efficiency and appropriate use of health resources.The application of medications was not mentioned in any study analyzed, showing that this practice, although understandable in certain contexts (cases in which the BHU are closed), is not consistent with urgency and emergency situations, and the users may seek a BHU to perform this procedure.
The significant demand for care related to cases of unprotected sexual exposure, shown in this study, specifically for the performance of Post Exposure Prophylaxis (PEP) and rapid tests (HIV, syphilis and hepatitis B), is a particular characteristic of the local organization of the municipality.The ECU selected to conduct this study is one of the references for the assistance to the population that demands the evaluation and dispensation of medications in order to prevent STIs, outside the conventional operating hours of the other services that operate in the same area. (25)s for the outcome of users treated in the ECU, most were discharged after treatment, in line with similar findings in other studies, showing that most of the complaints presented by users are of low complexity or not urgent.Considering the initial evaluation of users, vital signs are essential to verify changes in clinical status and assist professionals in risk classification, together with the complaint referred to correctly prioritize users, and must be carried out in a reliable and efficient manner.This and other studies revealed that, among the vital signs measured (systolic and diastolic blood pressure, heart and respiratory rate, body temperature and oxygen saturation), most of these presented means within the normal range in all categories.This correspondence between the normality of vital signs and the classification of users as nonurgent is consistent, as users with vital signs within the normal range usually indicate less serious clinical conditions, not requiring immediate care and the users may be directed to seek care in a BHU. (13,28).
Of the limitations, the study was carried out in a single ECU in the city of Curitiba, making the patterns of search for care and the characteristics of the sample specific to this location, limiting the applicability of the results to other regions.Another issue is the time frame used in the sample, not portraying all the diversity of cases over time and in different contexts.The presence of a pandemic period must be considered, which required reformulations in the organization of the municipality's health system, interfering with the perception and search patterns of users when seeking care.
Studies that use more comprehensive time frames and that are carried out in several Emergency Care Units can generate a greater number of data and enable a higher degree of understanding of the profile of non-urgent care.The identification and mapping of care can provide SUS managers with subsidies in the elaboration of health education strategies, improvement of the processes of the Urgency and Emergency Network and the strengthening of Primary Health Care and BHUs, as a gateway to the public health system.